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Patient selection and pathological outcomes using currently available active surveillance criteria
Author(s) -
El Hajj Albert,
Ploussard Guillaume,
Taille Alexandre,
Allory Yves,
Vordos Dimitri,
Hoznek Andras,
Abbou Claude Clément,
Salomon Laurent
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12154
Subject(s) - medicine , prostatectomy , prostate cancer , cohort , pathological , disease , population , stage (stratigraphy) , cancer , gynecology , surgery , paleontology , environmental health , biology
Objectives To establish the rate of higher risk criteria in various definitions of an active surveillance population.Patients and Methods Over a period of 10 years, 1161 patients were diagnosed with prostate cancer and underwent radical prostatectomy at our institution. Statistical analysis was performed comparing the rates of upgrading, extracapsular extension, seminal vesical involvment and unfavourable disease ( G leason score upgrading >6 and/or T 3 disease) for six groups of patients eligible for the U niversity of T oronto, R oyal M arsden, J ohn H opkins, U niversity of C alifornia S an F rancisco, M emorial S loan K ettering C ancer C enter and P rospective R andomized I nternational A ctive S urveillance.Results Active surveillance protocols including patients with biopsy G leason score 3+4 ( R oyal M arsden) had significantly higher rates of extracapsular extension ( P = 0.009), upgrading to pathological G leason >3+4 ( P = 0.004) and unfavourable disease ( P = 0.001) compared to the most stringent J ohn H opkins criteria. Unfavourable disease was found in more than 40% of patients in all series with no significant difference between the G leason 6 protocols. Biochemical recurrence‐free survival at 5 and 10 years was 76.7% and 63.3% for the entire cohort. Positive margins ( P < 0.001), pT3 tumours ( P = 0.006) and unfavourable disease ( P < 0.001) were significant predictors of biochemical recurrence.Conclusions Active surveillance in patients with G leason 3+4 presents a risk of missing unfavourable disease and should be limited to older patients with comorbidities. The differences in inclusion criteria between G leason 6 protocols did not have a significant impact on the pathological results.